Registration Form for the "Raising Dangerous Children" conference.

Registration Form

Please fill in the form below.
Full Name

First NameLast Name
First/Last Name of any other adults registering with you (18+)
Names AND ages of all children registering with you (17 and under)
Phone Number (Person Registering)

Area CodePhone Number
E-mail (Person Registering)
What Church Do You Attend?
Which Suburb / Town do you live in?
How did you hear about this event?

Other
Please tick which applies to you (if relevant)
Lunch will be provided at the conference (filled rolls etc.) If you require a Gluten Free option please indicate.
Suggestions or topics you would like to see addressed in the conference?
PAYMENT: Please select the option you wish to use. Cost is $15 per adult (18+).
PAYMENT
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Registration Fee (Required)$15.00 NZD

Quantity

Total $0.00 NZD
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Registration Form